Message from your ACHE Regent – Spring 2019

 I was just at a conference where an audience member made a comment to a speaker comparing what’s being asked of healthcare organizations to asking car windshield manufacturers to assume the risk for rocks falling from mountains.  

It’s fairly well understood that we are moving toward a paradigm of paying for performance/outcomes. We also hear – perhaps so often that it’s eyeroll-inducing – that only 10-20% of a person’s or population’s health is affected by healthcare delivery.  The rest fall into the bucket of social determinants of health (SDOH), which include healthy (or unhealthy) behaviors, genetics, the environment, and socioeconomic status. It is impossible to improve the health of the population by focusing on the delivery side alone. 

The SDOHs are the rocks falling from the mountain onto the windshield – they’re not something that the healthcare delivery system can do that much about. Paying for outcomes must be a fair fight – we must figure out a way to acknowledge that not all patient populations are equal when it comes to dealing with SDOHs.  

Another analogy that I’ve heard is that of the timer chips that runners have for races from 5Ks to marathons – these are devices that measure the runner’s time from when they cross the starting line, not from when the race officially starts. Without it, the runners who start out at the front of the starting line would have a huge advantage over the runners back in the pack who don’t even cross the starting line for another 10 minutes. We need something analogous to the timer chip in healthcare or we’ll end up penalizing those who have a more challenging population.

That being said, we have numerous examples of organizations that are doing great work to address some of the SDOHs in their communities. This profession is filled with mission-driven organizations and individuals, so I have full confidence that the issues of SDOHs will never be ignored. But, we also need to recognize that SDOHs are not the primary responsibility of healthcare to solve. Others need to be recruited to this fight.

As always, I would love to hear from you. I can be contacted at

Mark A. Sonneborn, FACHE
Regent for Minnesota